Facts about Jaw Pain

FACTS ABOUT JAW PAIN

Temporomandibular disorder (TMD) refers to a group of conditions that cause disturbances to the temporomandibular joint (joint of the jaw) or the muscles of mastication that surround the joint.¹

The mean age of onset of TMD is between 18 and 26 years old, and can affect anyone from any age group.^2,3 TMD has a higher frequency in women between 20 and 45 years old, with women being 5 times as likely to have TMD than men.^2,3 Many studies have also found a high occurrence of signs and symptoms of TMD in children, with the condition having a prevalence of between 6% and 68% in children and adolescents.³ Some studies have also observed that while younger participants with no objective signs of TMD complain of extreme pain, very elderly people presenting with objective symptoms of TMD do not complain of any pain.² In addition, of those suffering from TMD signs and symptoms, only 5% to 15% seek treatment.² Moreover, among those seeking treatment for TMD, majority of them are females.¹

Generally, the signs and symptoms of TMD include pain in the temporomandibular joint, cervical spine, face and ear region, muscle fatigue in the cervical and craniofacial region and mastication muscles, decreased range of or abnormal jaw movement and noises from the jaw joint.^1,3 The major cause of pain in TMD is due to the spasm of the mastication muscles, and may move from one place to another or be unilateral or bilateral.^2,3 TMD pain may be acute with slight and self-limiting. In other patients, the condition progresses to the chronic state and the pain becomes unrelenting.⁴ Other symptoms that may be present are headache, fatigue/muscle pain when chewing, having a habit of teeth clenching or grinding and emotional stress.³ TMD is may also be associated with osteoarthritis and rheumatoid arthritis in some patients.⁴

The methods used to treat TMD are classified into reversible and irreversible. Reversible treatment methods include counselling, heat, resting the temporomandibular joint, medications, behaviour modification, manual approaches and injections.^2,4 For irreversible treatments, such as surgery and orthodontic measures, there are more risks than benefits. Hence, they are not recommended if possible.²

For counselling, patients need to be educated on the natural history and course of TMD, the self-limiting nature of the condition, along with other necessary information. While providing counselling, health professionals will also provide the patient with reassurance and ensure that the patient knows that their emotional and physical strains due to TMD are understood.⁴ The administering of heat onto the sides of the patient’s face, using towels, bottles, or heating pads, may also help to relieve some muscle pain. To give their jaw rest, patients are also advised to avoid certain movements and habits that may aggravate the condition, such as chewing gum, yawning, jaw clenching and biting of fingernails.⁴

In terms of medications, non-steroidal anti-inflammatory agents and muscle relaxants are useful only in the acute phases of TMD. Antidepressants are also effective for treatment during the chronic stage of the condition.⁴ Behavourial modification includes the use of relaxation techniques, counselling and management of stress, and have found to be effective and helpful in treating TMD.⁴ Manual approaches which may be effective in treating TMD include soft tissue techniques, exercise, mobilization and manipulation. They help to recondition and retrain the masticatory muscles and other muscles which are often associated with TMD.^4,5

TMD patients are increasingly seeking the use of complementary and alternative (CAM) for treatment, with most patients seemingly preferring CAM over invasive conventional care. Chiropractic care is one of the most commonly accessed CAM treatment utilised by CAM patients.² In a survey conducted by Raphael et al., 9.5% of participants in the study utilised chiropractic treatment.² In another study, it was reported that chiropractic treatment involving the use of an activator adjusting instrument resulted in a reduction in TMD symptoms.^1,2 Similar positive findings were also reported by many supplementary TMD case studies.² Moreover, participants of a survey who selected CAM treatments to be effective for their TMD tend to be more healthy.²  Hence, chiropractic care is effective for the treatment of TMD and patients who prefer non-conventional care may utilise such treatments.

References

1. DeVocht JW, Long CR, Zeitler DL, Schaeffer W. Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument: a prospective case series. JManipulative Physiol Ther [serial online]. 2003 [cited 2017 Jan 25];26(7):421-5. Available from: ScienceDirect. http://sciencedirect.com/
2. Vinjamury SP, Singh BB, Khorsan R, Comberiati R, Meier M, Holm S. Chiropractic treatment of temporomandibular disorders. Altern Ther Health Med [serial online]. 2008 [cited 2017 Jan 25];14(4):60. Available from: ProQuest. http://search.proquest.com
3. Minghelli B, Cardoso I, Porfírio M, Gonçalves R, Cascalheiro S, Barreto V, et al. Prevalence of temporomandibular disorder in children and adolescents from public schools in southern portugal. N Am J Med Sci [serial online]. 2014 [ cited 2017 Jan 25];6(3):126-32. Available from: Academic OneFile. http://find.galegroup.com
4. Scrivani SJ, Keith DA, Kaban LB. Medical Progress: Temporomandibular Disorders. N Engl J Med [serial online]. 2008 [cited 2017 Jan 25];359(25):2693. Available from: ProQuest. http://search.proquest.com
5. Kalamir A, Pollard H, Vitiello AL, Bonello R. Manual therapy for temporomandibular disorders: A review of the literature. J Bodyw Mov Ther [serial online]. 2007 [cited 2017 Jan 27];11(1):84-90. Available from: ScienceDirect. http://sciencedirect.com/